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lheEvergreen ' • �O�n STRUCTION• •+ <br />CITY OF <br />everett • PERMIT PERM,T No: os53� <br />CITY HALL 259�8745 • <br />EVEPETT, WA 98201 ❑ COMBINATION � BUILDING ❑ MECHC.� �CAL ❑ PLUMBIN� - <br />OWN[R MnILAD�RE55 CRY 21P PY�NE <br />James M. Bloom 3530 Federal Avenue 98201 <br />ARCNRECT OR �ESIGNER MAIL ADDRG55 CITV ZIP PHONE <br />GENERaLWNTRACiOR MAILADDRESS CITY 2�P PHONE UGENSE/ <br />Same <br />MECNANICAL CONTRACTOP MAII. qDDRESS CITY ZIP PIIONE LICENSE 1 <br />MAIL AO�flE55 <br />Cltt ZIP PHONE UCENSE � <br />55 OF Y/ORK <br />❑NEW ❑ADDITION ❑ALTERATION ❑R[PAIR ❑DEMOLITION ❑FeNCE ❑SIGN C��ARAGE <br />.VATION OF WORK <br />E 45�.0� <br />iCRIpE WORK <br />construct car-port <br />Pii0PO5ED USE OF BUILOIt�G <br />sinale familv residence <br />LEGhI DESCPIi�t10N OF PROPEflTY �SHOW BELOW OR ATTACII FOUR GOPIES� <br />�or Z 9LOCK_OF Hili crest <br />Federal Avenue <br />PLUMBING <br />N0. TYPE OF FIXTURE <br />WATER CLOSET ROILET) <br />K!TCHEN SINK <br />DRINKING FOL'NTPIPI <br />F�OOR DRAIN <br />VACUUM BREAKERS <br />ROOF DRAINS — RAINLEADERS <br />SINK ISERVICE — BAR, ETCJ <br />SUB <br />SIDE YARD SETBACK STREET SET�ACK <br />6' 20' <br />USE ZONE <br />R-1 <br />TYPE OF CONS <br />V-N <br />SIZE OF BLDG. <br />20'X20' <br />FIRE ZONE <br />3 <br />LO7 AREA <br />OCCUPANCV GROUP <br />M-1 <br />NO. OF STORIES <br />1 <br />BASEMENT <br />none <br />REAH 1ARD SET�I <br />20' <br />\'ACANT SITE <br />❑YES GNO <br />NO. OF DWELLINC <br />MA%.00C.LOAD <br />FIRE SPRINKLERS <br />APPNOVALS BY <br />1. ENl9RONMENiALCHECKLIST <br />2. BUILDING PLANS <br />3. FIRE MYDRANT <br />a. FIRE PROT[C710N SYSTEM <br />5. GRADiNG <br />6. ORAINAGE <br />7. ENVIRONMEN7ALIMPAC75TATEMENT <br />B. HEALTH DISTRICT <br />APPLICA710N ACC. BY PLANS CHECKEC BY APPR. FOR ISSUANCE BY <br />V.C. <br />I HEREBY CERTIFY THAI I U4VE READ AND EXAMINED THIS AP• <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br />ALL PROVISIJNS OF LAWS AND ORDINANCES GOVcRNING THIS <br />TYPE OF WORK WILL BE COMPLIED WITH WHEIiIER SPECIFIED <br />HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT <br />PRESUI�IE 70 GIVE AUTHORITY TO VIOLATE OR C,i,P10EL THE PRO• <br />VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING <br />CONSTRUCTION OR TH[ PERFORMANCE OF CONSTRUCTION. <br />��$' TUFE OF CONiRFGTOR OF AUTH LEG GENi �ATE <br />-�� . 8/15/79 <br />i OF EOUIPME <br />— H.P. EA. <br />INITS — H.P. EA <br />GAg FIRED A'C. UNITS — TONI <br />FORCED AIR SYSTEAIS — B.T.L <br />WALL HEATERS — B T.U. <br />UNii HEATERS — 8 TL. <br />EVAPORATIVE COOLCRS <br />CLOTHES DRYERS <br />VENTILATION FAN <br />PANGEHOOD <br />AIR HANDLING UNIT — <br />STO'JE <br />MF.TAL FIREPLACE 8 CHIMiJEY <br />PWMDING <br />MECHANICAL <br />A! <br />rtt <br />EA. <br />M <br />M <br />GF <br />SUB TOTAL S <br />PENMIT S <br />TOTALFEE f <br />dBER PLAN CHECKFEE <br />FEE RECEIPT N0. <br />F�ES \ALUATION FEE <br />£450. 00 <br />U.B.C. <br />SEC.303(a) <br />� �� <br />'� � <br />PROPERLY VALIDATEU (IN THIS 5(A��7}115 IS v�l�i j��.Aly O._�y �� <br />O � U I� 7 Y �S7T <br />1 M <br />YOU:R REQEIP't � <br />7HAt'JK YO�! �' <br />, • ! � <br />' � � , <br />' .,'f r�i� i <br />' � � �R �4 <br />�� F . <br />